The biggest problem facing orthodontic practices in the United States is a lack of new patients. Though there are outliers who have more work than they can handle and despite other concerns, orthodontists are obsessed with how they can get more new patients and more case starts. And they should be. Orthodontists who own a practice are running a business that will cease to function without a regular influx of new customers starting treatment.
So here’s the rub.
The US economy is on fire, the stock market has never been higher and unemployment is effectively zero BUT STILL the biggest problem facing orthodontists is a lack of new customers. The implications are obvious and beg a few questions:
- What will happen when the next downturn in the economy comes along?
- Why aren’t more people buying orthodontic treatment from orthodontists now when things are good and consumer confidence is high?
- What’s the biggest impediment to customers seeking and purchasing orthodontic treatment?
- What will happen when the already small number of available customers becomes significantly smaller?
The answers to these questions are obvious, or they should be, but we orthodontists refuse to even consider changing “the way we have always done it”.
Let me take this one step further. I’ll go on the record right now and say that in the next 5 years one (or probably all) of these things will happen in the US:
- There will be a significant downturn in the economy/stock market with all the associated sequelae.
- Doctor directed, remote treatment with clear aligners via teledentistry will become mainstream.
- There will be serious, like really serious, downward price pressure on in person orthodontic treatment.
So what is one to do? What’s the solution? Simple. Figure out how to deliver the services consumers want within the price and time constraints they have and do so before any of these three things happen. The easiest ways to accomplish this are to modulate service/lower price and incorporate teledentistry into the modern orthodontic practice. Of course whenever I suggest such things there are howls of disagreement and declarations like:
- I have too much overhead already, I can’t lower my fees.
- I have too much student debt, I can’t lower my fees.
- Low fees mean low quality, I won’t lower my fees.
- My time is valuable and I’m a professional, I won’t lower my fees.
- My patients pay for the best, I have no need to lower my fees.
And if you believe these are good reasons to keep doing what you’ve always done even though you lack new patients in one of the hottest economic periods ever, then that’s up to you. Let me know how that works out for you. If you have plenty of new patients and are happy with how your business is doing then keep doing what you’ve always done! I’m talking to people who are dissatisfied with their results but refuse to change.
One of the semi-legitimate reasons orthodontists give for not changing from the traditional delivery model to a more relevant one is that they own or are vested in their physical plant (aka office building or buildout/leased space). Having an established physical plant that is antiquated in time, space, location and function certainly is a millstone to drag around and limits flexibility but even this can be overcome. The smart doctor should consider selling their practice while the market is hot. The prices being paid for orthodontic practices are unprecedented, the buyers plentiful and the terms favorable. Even if you’re relatively young I’d still urge you to consider this path. I have several friends who have sold recently and they are ecstatic about the results – they cashed out at the top of the market, put away big bucks, agreed to work 2-5 years running the practice they sold, are paid well for doing so, enjoy the practice of orthodontics without the hassle of running a business AND if they decide to do so in the future they can relocate and construct an ideal office in an ideal location to deliver orthodontics in the manner patients want instead of the way we have always done it. These doctors get to keep all their knowledge, shed all their baggage and get paid well for doing so. If you decide to have a look at your options feel free to contact me and I’ll connect you directly with several buyers – no need to get some broker between you and the buyer to cut into your nest egg! You can get several offers and choose from among them. When practice buyers compete, you win!*
Still think it’s crazy to sell at your age? Well consider one more thing. For what it’s worth, I’m not convinced that the prices that are being paid for practices are sustainable. If the purchase price of practices keeps going up and the price of orthodontic treatment keeps going down, at some point those lines must intersect and that will be the end of the sweet deals that are currently available. For that matter if any of the three things above I’m predicting actually happen, that will be the end of high practice purchase prices as well. Something to think about.
The choice is yours. You have options. You can open your mind, adjust to the new reality, provide great service, grow your practice, have a great attitude, enjoy your success and keep rolling along in solo practice. OR you can cash out, put away a bunch of money, be “just a doctor” and enjoy being part of a bigger group. OR you can do any combination of these things in any order you choose! Of course most of us will choose to do nothing and hope “it won’t happen to me” as we orthodontists have collectively done for decades. If our past is any predictor of what will actually happen, those orthodontists who are currently doing well will continue to do so and those who are not will bemoan all the external forces they blame for their lack of success but never realize that if they refuse to change their mindset they will never change their circumstances.
*I have helped facilitate several of these deals and I have always refused to take a finder’s fee or any other kind of remuneration for doing so. I don’t want or need a cut of your money!